Awareness, uptake, and barriers to vaccination against respiratory tract infections in patients with diabetes mellitus: A multi-center study in Saudi Arabia

Diabetes mellitus (DM) predisposes individuals to respiratory tract infections (RTIs), making vaccination an essential preventive measure; however, evidence regarding vaccination awareness, uptake, and barriers among DM patients in Saudi Arabia is limited. This study aimed to assess the awareness, uptake, and barriers related to influenza, pneumococcal, and COVID-19 vaccinations among adults with DM in Saudi Arabia. A cross-sectional survey was conducted between December 2023 and March 2025 among 1,556 adults with type 1 and type 2 DM attending endocrinology clinics across three sites. A structured questionnaire evaluated awareness, uptake, and barriers, and data were analyzed using descriptive statistics and chi-square tests. Uptake rates were 60.8% for influenza, 88.7% for COVID-19, and 27.1% for pneumococcal vaccines, with pneumococcal vaccination lower in type 1 than type 2 DM (23.2% vs. 28.5%; <i>p</i> = .002) and COVID-19 vaccination higher in type 2 DM (90.1% vs. 84.6%; <i>p</i> = .001). Influenza infection was more common in type 2 DM (58.6% vs. 52.4%; <i>p</i> = .030), while pneumonia was less frequent in type 1 DM (10.2% vs. 16.3%; <i>p</i> = .003). Overall, 82.6% recognized the purpose of vaccination and 70.4% agreed that DM patients should be vaccinated, though misconceptions persisted, especially regarding pneumococcal vaccine efficacy. Healthcare providers were the main information source for influenza (45.6%) and pneumococcal vaccines (23.6%), while social media predominated for COVID-19 (49.1%). Despite reasonable awareness, vaccine uptake remains suboptimal, highlighting the need for targeted education and stronger healthcare provider engagement.